Knee > Baker's Cyst > Treatments

   Excision

Preparing for Surgery

While you are preparing to undergo an excision of a baker's cyst, the decisions you make and the actions you take before your surgery can be as important as the procedure itself in ensuring a healthy recovery.

   Make sure you have received any equipment you will need when you get home from the hospital. This may include a knee brace, crutches, ice packs or coolers, or a continuous passive motion (CPM) machine. You should receive prescriptions for any of these from your doctor when your surgery is scheduled.

   Understand the potential risks and benefits of baker's cyst excision, and ask your surgeon any questions that will help you better understand the procedure. It can also help to talk to someone else who has undergone the same surgery.

   Any physical problems, such as a fever or infection, should be reported to your surgeon, and you should notify your surgeon of any medication you are taking.

   If possible, practice walking with your crutches in case you need to use them after surgery.

   Most insurance companies require a second opinion before agreeing to reimburse a patient for a surgical procedure. Getting a second opinion from a surgeon who is as qualified as the surgeon who gave the initial diagnosis is advisable in any case.

   Make sure the orthopedist performing the surgery is board-certified, which can be determined by calling the American Board of Orthopaedic Surgery at 919-929-7103.

Here are some important steps to remember as you prepare to go to the hospital or outpatient clinic for your baker's cyst excision surgery:

   At most medical centers, you will go to "patient admissions" to check in for your aspiration procedure. Aspiration is usually an outpatient procedure but there may be a separate department for inpatient surgery, so be sure to ask your doctor.

   After you have checked in to the hospital or clinic, you will go to an area where the final preparations are made. Paperwork regarding your medical history and medication allergies is completed and your knee area may be shaved (this is not always necessary). You will wear a hospital gown and remove all of your jewelry.

   You will meet the anesthesiologist or nurse anesthetist (a nurse who has done graduate training to provide anesthesia under the supervision of an anesthesiologist). Then, you will walk or ride on a stretcher to the operating room. Most patients are not sedated until they go into the operating room.

   You will probably be told not to eat or drink anything after midnight on the night before your surgery.

   Since you will most likely be able to go home within a few hours of surgery, and because the anesthetic and pain medications may make you drowsy, arrange for someone to drive you home when you are released.

    Wear a loose pair of pants or other clothing that will fit comfortably over your knee bandage when you leave the hospital.

   Take it easy. Keeping a good frame of mind can help ease any nerves or anxiety about undergoing surgery. Distractions such as reading, watching television, chatting with visitors, or talking on the telephone can also help.

Surgery to excise a baker's cyst usually takes about an hour or less, depending on the size of the cyst. A larger cyst requires a more delicate procedure that takes more than an hour because it may have swollen around nerves and blood vessels. After anesthesia is administered ­- which may be local, regional, or general ­- the surgical team sterilizes the leg with antibacterial solution. Then, the instruments are set up and the television monitors are turned on.

   The surgeon makes two small three- to four-millimeter incisions directly above the cyst.

   All tissues surrounding the cyst are cut away and the cyst is drained of fluid. The knee problem that has caused the cyst, usually a cartilage (meniscus) tear, is repaired or smoothened.

   The cyst usually resolves on its own. Physicians do not typically make an effort to remove the entire cyst.

   The incisions are closed with stitches.

   You are awakened and taken to the recovery room

Following excision of your baker's cyst, you usually stay in the recovery room for at least two hours while the anesthetic wears off. You will be given adequate pain medicine, either orally or through an IV (intravenous) line, as well as instructions for what to do during the next few days. In addition, you will be given an appointment to return and a prescription for pain medicine. Your knee will be bandaged and may have ice on it. There will likely be pain, and you can expect to be given pain medication as needed. Be sure to ask for medication as soon as you feel pain coming on, because pain medication works best on pain that is building rather than on pain that is already present. The nurses will not give you more than your doctor has prescribed and what is considered to be safe. You should try to move your feet while you are in the recovery room to improve circulation. Your temperature, blood pressure, and heartbeat will be monitored by a nurse, who, with the assistance of the doctor, will determine when you are ready to leave the hospital or, if necessary, be admitted for an overnight stay. It is likely that you will be able to bear some weight on your leg, but your surgeon may suggest that you use crutches or a cane for a couple of days. For most people, crutches are used only until you feel steady on your feet. As soon as you are fully awakened, you are usually allowed to go home. You will probably be unable to drive a car so be sure to have arranged a ride home.

It typically takes around four weeks after baker's cyst excision for the wound to completely heal. A firm bump of scar tissue will form in the incision. As the wound heals, the bump will slowly go away. Stitches are usually removed about two weeks after surgery. You will likely feel pain or discomfort for the first few days, and you will be given a combination of pain medications as needed. A prescription-strength painkiller is usually prescribed and should be taken as directed on the bottle. Taking one every four to six hours as directed is a good idea in the first 24 hours to suppress pain. Here is what you can expect and how you can cope after excision:

   There may be some minor drainage on the dressing since fluid may have accumulated during surgery. In addition, expect some blood to show through the bandage during the first 24 hours.

   You should usually continue with the ice for at least 24 hours and remove the dressing within the first 48 hours. Icing your knee for 20 or 30 minutes two to three times a day during the first two days will help reduce pain. Ice therapy is most effective in the first 24-48 hours.

   As much as possible, you should keep your knee elevated above heart level to reduce swelling and pain. It often helps to sleep with pillows under your ankle.

   Wait until you can stand comfortably for 10 or 15 minutes at a time before you take a shower. You can probably shower the day after excision. A stall type shower is usually the best. If you have a tub shower, be careful entering and exiting the tub.

   Crutches or a cane may be needed for a few days, but you can usually put your weight on your knee and begin walking. The pain typically feels like you bumped into a table. The incision may sting if you flex and extend your knee, so try to minimize movement for about a week.

   For two or three days after surgery, you may experience night sweats and a fever of up to 101. Your physician may suggest acetaminophen, coughing, and deep breathing to get over this. This is common and should not alarm you.

   As soon as possible after surgery, you should begin doing physical therapy as directed by your surgeon.

   You may return to work the next day after excision, depending on the severity of your pain.

The underlying cause of your baker's cyst, whether it was arthritis, torn cartilage, or other knee problems, usually dictates the specific rehabilitation program you need to undergo. You can begin physical therapy within 48 hours after excision in most cases, depending on the overall condition of your knee. After excision, you usually need to avoid strenuous activities that put pressure on the bones in your knee. Running, jumping, or twisting may aggravate the synovial membrane and increase its production of fluid, causing your cyst to swell again. The rehabilitation program to help heal your knee after a baker's cyst excision is usually similar to the program used to heal a meniscus tear. Your physician or physical therapist usually designs a custom rehab program that follows a general pattern. For one to two weeks after surgery, you should typically rest your knee to allow the incisions to close properly. Your physical therapist can teach you stretches and mild exercises to increase your range of motion. After healing, it usually takes two to six weeks of strengthening exercises to ensure you have proper muscle strength to support your knee. Continuing to visit your therapist can help you learn the proper form and approach to the recommended workout. After about six weeks of rehab, physical therapy can typically become activity-oriented as you regain the ability to perform complicated movements, using stationary bikes, elliptical machines, and cross-country skiing machines. When you feel comfortable performing these gym activities, you are usually ready to return to your favorite recreational activities. Physicians usually suggest that you continue strength training even after your knee has been rehabilitated. Have your physician periodically check your knee for strength and signs of a recurring baker's cyst.

The best way to prevent a recurring baker's cyst is to properly treat the knee problem or disease that caused the cyst. In the absence of other knee complications, the amount of caution you should use during activities to prevent a baker's cyst from recurring depends on your age as follows:

   Children ­ Baker's cysts rarely effect joint function. Once cysts heal, they rarely return.

   Adults ­ The cyst could be a sign that you have sustained some degree of cartilage damage. Becoming less involved in strenuous activities, like contact sports or long distance running, may help prevent future baker's cysts. But you do not need to avoid activities or be overly concerned with prevention unless the underlying cause of your baker's cyst was a severe disease or injury that warrants extra prevention measures.

   Seniors ­ Because baker's cysts are common companions of rheumatoid and osteoarthritis, you should strongly consider cutting back your activity level to avoid situations that could strain your knee joint. A baker's cyst may be more problematic later in life, harming the function of your knee joint, and you should continue to visit your physician for check-ups after the cyst heals.

Weight control is also important. One extra pound of body weight translates into three or four pounds of weight across your knee every time you take a step. Lightening the load on your knees helps them to function better.